With their daughter, Charlie Jo, a year and half old, Todd Israel and his wife, Jennifer, decided around the end of 2014 to have another child.

“For many years, through my 40s, I knew I was heavy, but I could handle it,” said Israel, now 52. “I didn’t have aches and pains or joint issues or anything else. I was really lucky. But I was just like, man, if I don’t do something I’m not gonna make it.”

As a New Year’s resolution, he decided to get in shape. But he hadn’t seen a doctor in 30 years, and by February 2015, he realized he needed help.

Going All In

In late February, Israel attended a free information session at Mission Weight Management, and after going to the orientation in March, he “decided to go all in”—he was willing to take any measure, including surgery.

Weighing for the first time in 30 years, he was at 535 pounds. “I had a vision of my children growing up and I wasn’t going to be there,” said Israel. “Talk about an eye-opening experience.”

According to W. Alan Bradshaw, MD, FACS, general and bariatric surgeon, candidates for bariatric surgery have to have a body mass index (BMI) of 35-40 with health problems, or a BMI of 40 or above with or without health problems, to qualify for a procedure.

Israel’s weight put him well above a BMI of 40, but despite his weight and not having seen a doctor for many years, the only health issue he had was high blood pressure. After having an endoscopy, colonoscopy and a sleep apnea study, Sharon Hathaway, MD, of Mission Weight Management Center, told Israel he would have to lose 70 pounds before being referred to a surgeon. With his surgery scheduled for September 29, Israel lost another 30 pounds. “I lost a hundred pounds on my own—I was very proud of that,” he said. “So when I went in for surgery, I weighed 435 pounds.”

Enrolling in the weight loss program at Mission Weight Management is a requirement for preparing for weight loss surgery through Mission. It includes several months of evaluations with internists, doctors, nutritionists and other team members. Participants are encouraged to lose 5 percent of their presenting body weight before their surgeries. “It improves their metabolism, shrinks the size of their liver and makes the performance of the procedure more easily achieved,” said Dr. Bradshaw, who is president of Regional Surgical Specialists in Asheville.

Bypass vs. Sleeve

There are two primary types of bariatric surgery: laparoscopic Roux-en-Y gastric bypass, or simply “gastric bypass,” and laparoscopic sleeve gastrectomy. In determining which procedure a patient will receive, surgeons look at whether or not the person also suffers from acid reflux or a prolonged history of insulin dependent diabetes. “My No. 1 determining factor is whether or not the patient has severe acid reflux,” said Dr. Bradshaw. “If they do, I’ll select a gastric bypass, because it diverts acid downstream and prevents it from coming up into the esophagus.”

Each procedure has advantages and disadvantages that should be weighed against a patient’s personal health status and history. Ultimately, it was determined that Israel should receive a sleeve gastrectomy.

By-the-Book Recovery

After surgery, Israel had no complications. “They stressed to us that everybody’s recovery is different, and my recovery was really by the book,” he said. “I had surgery on Tuesday, came home on Thursday and stayed out of work the following week as a precaution. I felt good.”

Full recovery from bariatric surgery typically takes a couple of months, but most people can go back to work in two to three weeks, said Dr. Bradshaw. There are dietary restrictions starting out, including a liquid diet for three weeks following surgery. Patients must also avoid heavy lifting until they’re fully recovered.

“I put my recovery all on the thoroughness of Dr. Bradshaw and the postoperative care, and also attending the support group,” said Israel. “I’m a Mission Weight Management support group junkie. Happy is not the word … I feel like I got my life back, I feel like my future with my wife and my children is just limitless.” (Israel and his wife now have a second daughter, Emmy Lou.)

Dr. Bradshaw credits Israel for his motivation. “If you’re not motivated, you’ll never be completely successful at this,” he said. “Once Todd decided he was going to lose weight and got into the weight management program, he was motivated to start losing weight immediately. He has been incredibly positive and really energetic throughout the process, and I think that that’s one of the reasons why he’s done so well. We always tell people that the procedure accounts for about one-third of their success, their diet another one-third of their success and exercise the remaining one-third of their success. If one part of that is not firing on all cylinders, the success rate goes down.”

Although some people, said Israel, choose not to tell many others about their bariatric surgery, he chose to tell everyone. “Here at my job, my customers and co-workers, they help me be accountable,” he said. “I shared my story and what I wanted to do, what my goals were. My family has been 100 percent behind it.”

There’s no doubt at all that Israel is happy with his decision. Today, he weighs 245 pounds and wears an XL instead of a 7X shirt. “I’d shout it from the rooftops,” he said. “Don’t hesitate to claim your life back. This is not the easy way out, it’s not taking a shortcut, it’s not something to be ashamed about. I found I put myself in a box and put limits on my life and my lifestyle without knowing it. I feel like part of my journey is to be an advocate for people diagnosed as morbidly obese—as ugly a word as that is. I want those people to take their lives back.”

Todd’s Weight-Loss Tips

For Todd Israel of Hendersonville, having bariatric surgery was one of the best decisions he ever made. He’s lost 290 pounds—down from 535. “And I hope I’m not done yet,” he said. Here are a few tips that helped him through his weight-loss journey.

Don’t think of bariatric surgery as selfish. “People talk about this as a very selfish thing to do. I say it’s most selfless selfish thing you can do. It’s selfish because it’s all about me … but it’s selfless because of the rewards my children, my wife, my family and my friends get from me being healthy.”

Don’t be afraid to ask for help. “There’s nothing easy about this. Take a cold hard look at yourself in the mirror and be honest and say, ‘I need help.’ I feel bad for people who are like I was, allowing themselves to be boxed in on their own and not realizing there’s help out there.”

Buy into the program. “[Mission Weight Management] knows what they’re talking about. They’re here to help us. The dietician is the single most awakening thing I’ve ever experienced when it comes to food. Having someone explain to you your metabolism and why eating more often is better than skipping meals, and putting me on a food plan, and telling me if you follow this plan what can happen.”

Attend the support groups. “There’s something about sitting in a group with someone who’s had the same experience I’ve had. When you start feeling something odd, and they can tell you, ‘I had this same experience.’ I got to 535 pounds all by myself, and it’s taken a whole group of people to get me to 245, so I can’t not continue with those groups if I want to have success.”

Know your motivation. “I’m not going to tell you there’s not been down times, hard times. And I tell people in the group, ‘Whatever your motivation—and mine is my children—when times are tough, focus on that.’ If I’m tempted to get a donut, I might need to just pull out a picture of my family and say, ‘Is that donut worth it?’”